Pain-related Stigma in Adolescents with Disorders of the Gut-Brain Interaction: Longitudinal Effects on Health Outcomes - PROJECT SUMMARY Disorders of Gut-Brain Interaction (DGBI), a group of gastrointestinal disorders involving chronic abdominal pain, are the second most prevalent type of chronic pain in childhood behind headaches. Youth with a painful subset of DGBI (DGBI-P; functional dyspepsia, irritable bowel syndrome, functional abdominal pain disorder, and abdominal migraine) suffer from recurrent and persistent pain and often experience negative social judgments of their condition from individuals in their social network: parents, siblings, friends, teachers, and healthcare providers, among others. These stigma experiences interfere with supports that normally protect against worsening disease in adolescence. Pain-related stigma is a significant public health priority due to its potential impact on delayed diagnosis, impairment in recovery, and long-term health outcomes. This multi- center study is designed to longitudinally evaluate the relationship between pain-related stigma and long-term health outcomes (e.g., disability, psychological distress, social functioning) in a cohort of 230 adolescents with DGBI-P (ages 12 – 17). This objective will be achieved by comparing reports of pain-related stigma at multiple time points (0, 3, 6, 9, 12 months) to concurrent assessments of health outcomes. Paired with this longitudinal analysis, we will describe the relationship between pain-related stigma and physiological stress via allostatic load markers in adolescents with DGBI-P. Allostatic load may serve as a biological proxy of social stress, with high allostatic load representing repeated or chronic exposure to stress that dysregulates stress-related systems (e.g., immune, metabolic, cardiovascular, neuroendocrine). We will assess allostatic load as a biomarker of stress in adolescents through the collection of saliva samples, blood pressure, body-mass index, and waist-hip ratio at each of our time points. Finally, we will explore potential risk and resiliency factors between pain-related stigma and health outcomes through the use of surveys in our study cohort. The proposed work is novel in that it is the first study to investigate pain-related stigma in youth longitudinally, and the first to analyze distinct sources of this stigma (e.g., peers, family, school personnel, medical providers) to assess their effects on adolescents' long-term health outcomes. Results from the prosed study will pave the way for clinical interventions tailored to the unique social contexts of youth with DGBI-P. Previously, no studies have explored pain-related stigma longitudinally, which has reduced scientific comprehension of this stigma's temporal dynamics, developmental implications, and effects on long-term outcomes. In alignment with stigma theory, we will examine pain-related stigma as a multifaceted phenomenon (e.g., felt, internalized, anticipated) to identify potential interventions for youth with DGBI-P.
